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General NPI Number Information
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NPI Number | 1336285113
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Entity Type | Organization
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Legal Business Name | ERIC W HICKMAN DDS INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 3116 L MONTGOMERY RD
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City | MAINEVILLE
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State | OH
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Zip | 45039
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Country | US
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Telephone | 513-697-9772
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Fax | 513-697-0227
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Provider Business Mailing Address
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Address Line | 3116 L MONTGOMERY RD
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City | MAINEVILLE
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State | OH
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Zip | 45039
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Country | US
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Telephone | 513-697-9772
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Fax | 513-697-0227
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Authorized Official
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Title or Position | ORTHODONTIST PRESIDENT
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Name | DR. ERIC WAYNE HICKMAN
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Credential | DDS MS
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Telephone | 513-697-9772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30020260
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License Number State | OH
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